SBAR

Communication Model
Situation, Background,
Assessment, and
Recommendation
 Objectives

Familiarize what SBAR stands for.

Establish reasononing why SBAR is
important to use.
Describe how SBAR affects patient
safety.
Describe the difference between
assertiveness and aggressiveness.
Verbalize appropriate responses in
practice scenarios.
 SBAR
Ineffective communication
poses a significant threat to the
safety of hospitalized patients.
SBAR is a usefuLand effective
Communication tool that
allows healthcare professionals
to share concise but important
information in a short amount
of time.
Michael Leonard, physician leader for
patient safety at Kaiser Permanente
introduced SBAR that was modified for
use in health care from the method used
in the aviation industry to reduce
communication errors among crew
members report in a
narrative form.
Physicians are
taught to
communicate using
brief "bullet points
that provide key
information.
SBAR - why it is important to use
According to the Joint Commission,
communication issues are the leading cause
of sentinel events in hospitals.
Improving the exchange of information
between nurses and physicians have been
cited as a key element to preventing
/medical errors and promoting a safe
z environment.
(Manning, 2006)
Miscommunication leads to patient safety
issues.
(HCPro, 2004)
 SBAR Communication Model
Easy to remember tool that provides
a structured, orderly approach to
improve effective communication
of accurate, relevant information.
The goal is to deliver your message
/in 1 to 1 !/> minutes.
Helps limit the jargon, keeps the
message clear, and removes the
influence of hierarchy and
personality.
 SBAR broken down...

SITUATION: State what is happening

at the present time that has
warranted the SBAR
communication. (State your name
& unit, what patient you are
/calling about, & what the problem
/ is)
 SBAR broken down...

ITUATION:
Example:
Hello Dr., this is, from unit. I
am calling about (pt name & room #)
The patient's code status is. I have just
assessed the patient myself. I am concerned
/dbout ________________ . (Examples can be
I BP over or under parameters, pulse over 140
or less than 50, respirations less than 5 or over
40, elevated temp or many other situations).
Note: These are examples, your hospital or
physician may have established parameters
\to call about.___________________ ____________
 SBAR broken down cont'd...

BACKGROUND: Explain
circumstances leading up to this
situation. (State admission
diagnosis, date of admission, brief
pertinent medical history, and
treatment to date)
 SBAR broken down cont’d...

BACKGROUND
Example:
The patient’s mental status is
vital signs are » skin is
02 js (not on) or on at, oximeter
reading is at, the patient
mplains of.
 SBAR broken down, cont'd....

ASSESSMENT: Indicate what you

think the problem is (Provide
last vital signs, oxygen if being
used, & any changes from prior
assessment: vital signs, heart
, mythm, pain, wound drainage,
Uneuro changes, etc.
 SBAR broken down, cont'd....

ASSESSMENT:
Example:
I believe the problem is: (state what
you believe the problem is, i.e.
cardiac, infection, neurologic,
respiratory, other).
R: I don’t know what the problem is
ut the patient is deteriorating.
te: The patient seems to be unstable.
 SBAR broken down cont'd....

RECOMMENDATION: Express what

you believe the patient needs or
what order specifically you want i.e.
give fluids, order labs, x-ray, have
the physician come see the patient,
transfer the patient to ICU, ask for a
(consulting physician to see the
Watient, etc.
 SBAR broken down cont'd....

RECOMMENDATION: Express what

you believe the patient needs or
what order specifically you want i.e.
give fluids, order labs, x-ray, have
the physician come see the patient,
^transfer the patient to ICU, ask for a
^consulting physician to see the
Watient, etc.
___SBAR broken down cont'd....
^Commendation: Example:
I suggest/request/recommend that you
(see immediately, transfer the
patient to ICU, ask the hospitalist/resident
to see the patient now, talk to family
about code status, etc.
Oy Suggest tests/interventions that
W>uld be needed (Chest x-ray, ABG’s,
Wg, CBC, BMP, give additional fluids,
raain meds, etc.) If no improvement, when
should we call again?
 Sample of SBAR worksheet to use
organize your thoughts
SOAR roport to ph/woan abovl • crHKOl *-1ua«K><>

There are several

examples of SBAR
worksheets that you can
find on-line that are
designed for calling a
gan, and others for
h change of shift
Some are even
Ity specific such as
NICU, ICU, and
 Sample of SBAR worksheet to
z organize your thoughts
Also recommend
viewing some of the
SBAR videos found
on Youtube for
Doth good and
pad examples of
$B/AR in use as
another learning
total for you.
 Practice example of making
a recommendation: The “R”
in SBAR: Which is better?
A. The nurse picks up B. The nurse says "I
the chart & notices noticed that Mrs.
that the physician did Smith’s het was 26
not order labs despite yesterday, what
a low hematocrit. The about repeating the
nurse says “excuse hematcrit?”

V me, did you want to

order labs today?”
 Practice example of making
a recommendation: The “R”
in SBAR: Which is better?
A. The nurse picks up B. The nurse says "I
the chart & notices noticed that Mrs.
that the physician did Smith’s het was 26
not order labs despite yesterday, what
a low hematocrit. The about repeating the
nurse says “excuse hematcrit?”
. me, did you want to
\ order labs today?"
 Importance of Effective
Communication
Nurses are the front-line care givers
responsible for notifying physicians
of patient care issues, acting as
the patient advocate, &
Protecting the patient from further
/harm, yet current nurse-physician
' relationships & cultures often do
not empower nurses to
communicate effectively with
Anhvsirians_________________ ____________
Ways to Improve Communication

• Work at developing
relationships with a personal
connection, ask about their
weekend, family, etc.
• Don’t be afraid to use humor in
your communications as you
develop relationships based on
mutual respect
• Be prepared with all relevant
^formation before making the
/call or starting the conversation
, And, most importantly, utilize a
; concise communication model
such as SBAR when providing
\ patient information
 Improving Communication, cont’d

•Assume that you and the physician are

on the same team & that you have
the same broad goals for the patient.
^Stressing again to be ready with
i patient data before you call or
communicate with the physician.
■rCc/mmunicate clearly your title & your
Relationship with the patient, example
Wimary nurse, wound care nurse, etc.
 Improving Communication, cont’d

►Connecting on a human level can be

a powerful catalyst.
Utilize appropriate assertiveness (not
aggressive) as you advocate for your
pathent.
 Characteristics of an Assertive
k Nurse (versus aggressive)
Appears self-confident & composed
Maintains eye contact
Uses clear, concise speech
•Speaks firmly & positively
Is non-apologetic
Takes initiative to guide situations
•Gives the same message verbally &
nonverbally
•Speaks genuinely, without sarcasm
(Communication in Nursing, 2004)
Dealing with Difficult Physicians or
Other Healthcare team members

•■Connecting on a human level

can be a powerful catalyst.
• Do not be afraid to express
what you think and believe
about this patient.
Have a memorized response
to fall back on so you can
respond when caught off
guard by an inappropriate
comment or behavior.
 Examples of a response to have
prepared in your mind when caught off
guard by rude behavior
• “I am almost through, and would like
to finish my thought."
• ‘‘Please don’t yell at me, I am here to
do what is best for the patient.”
•“You are being rude and
inappropriate, it is not helping us take
care of the patient."
Take 5 minutes right now and come up
with a comment that you can memorize
and have available
 Dealing with difficult physicians
& others on the healthcare
team
Remember:
Nobody benefits if the nurse
doesn’t assert themselves
under certain conditions.
This does get easier with
practice and being
prepared!
 Summary
Use of SBAR to organize the exchange of
information has demonstrated effectiveness in
reducing communication errors (Beyea, 2004)
Promoting nurses' confident use of SBAR has great
potential to decrease miscommunication and
increase patient safety
Nut^es may experience discomfort using SBAR
because it moves beyond the traditional
approaches of merely reporting information into
newer territory of joint decision making which
Includes providing opinions and making
recommendations
 Summary, cont'd

Commit to practicing using

the SBAR model until it
becomes your normal routine
Role playing in the context of
communicating with a difficult
physician (and using your
memorized statement) may
also be helpful to improving
your ability to communicate
effectively